In a report entitled “Safe but Soulless — Nursing Homes Need a New Narrative” published by Lien Foundation and Khoo Chwee Neo Foundation in 2016 as part of their advocacy project focused on improving Singapore’s nursing homes, one statistic jumped out at me. In 2015, Singapore’s has 26.1 nursing beds per 1000 people aged 65 and above — which at that time, was the lowest in the past 15 years. By contrast, the OECD – an organization made up of developed countries – has an average of 45.2 beds per 1000. Even with the Singapore government’s effort to add capacity, the target is only 28.3 beds per 1000 by 2020.

Is it a good thing that only about 2% of Singaporeans over 65 live in nursing homes versus 6-8% in northern Europe and Australia? Here are some reasons why we believe Singapore is different from other developed countries.

• Compared to the West, traditional Asian families have stronger family networks that can provide care at home and few see the need to send their aged to nursing homes. But is this a sustainable trend as family size shrinks and more caregivers having to work – leaving no one at home to take care of the aged? Together with a population that is likely to live well into the 90s, those taking care of their aged loved ones may themselves be over 65 as well.
• To reduce the burden on the public healthcare system, the government prefers that as long as possible, nursing homes should be considered an option based on need and not by choice. Today, the government subsidizes about 9 in 10 nursing home residents. And this poses a significant strain on future healthcare budgets if left unchecked. (In 2015, the government budget has tripled to $360 million in 4-years but still only accounts for about 4% of the overall health budget. This is expected to go up.)
• Singaporean view nursing homes unfavorably and considers them “refuge of last resort”. Many families still believe that sending their aged loved ones to nursing home is an abdication of their filial responsibility. Government policies have also strengthened this perception.
• Most Singaporean have no real idea or understanding of what happens inside a nursing home — until they are confronted with the need for one. Overwhelmingly, the public’s perceptive is that nursing home is not a nice place – crowded with residents that are generally abandoned by their loved ones. Today’s nursing home is a far cry from those in the 1990s and has changed for the better.
• There is also a perception that nursing home is not affordable. That is true for most families. Without government subsidies, most families simply cannot afford a nursing home bed that starts at about $2,000 and can go a much as $6000 per month. Even with more nursing homes coming online by 2020, it is not likely that the costs will come down. If anything else, it is likely to increase.

Singapore has to answer a difficult and complex question – do we follow what other developed countries are doing in building more nursing homes to cater to our ageing population? Or is the need for more nursing homes driven by default due to the lack of alternatives in caring for the aged? Should Singapore invest its resources in home and community care versus a more clinical model of nursing home care? Stay tuned. The debate is far from over.

Download the full report here.